What is Wavefront Aberration? Custom Contact Lenses For Vision Improvement Are They Feasible In A Disposable World?
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1 Custom Contact Lenses For Vision Improvement Are They Feasible In A Disposable World? Ian Cox, BOptom, PhD, FAAO Distinguished Research Fellow Bausch & Lomb, Rochester, NY Acknowledgements Center for Visual Science, University of Rochester Geunyoung Yoon Jason Porter Tae Moon Jeong Ramkumar Sabesan Dave Williams Antonio Guirao Bausch & Lomb, Rochester R&D Griff Altmann Gary Richardson Michele Lagana Ravi Somasundurum Tim Green Daozhi Wang Amanda Kingston Alexis Vogt What is Wavefront Aberration?
2 Sources of Retinal Image Blur Diffraction Aberrations Light Scatter Point Spread Function vs. Pupil Size Perfect Eye 1 mm 2 mm 3 mm 4 mm 5 mm 6 mm 7 mm Point Spread Function vs. Pupil Size Typical Eye 1 mm 2 mm 3 mm 4 mm pupil images followed by psfs for changing pupil size 5 mm 6 mm 7 mm
3 What is the Wavefront? parallel beam = plane wavefront ideal wavefront defocused wavefront What is Wavefront Aberration? parallel beam = plane wavefront ideal wavefront aberrated beam = irregular wavefront Wavefront Aberration of a Surface 3 Wavefront Aberration mm (superior-inferior) mm (right-left) 3 Dimensional View 2 Dimensional View
4 How Do We Measure Wavefront Aberrations of the Eye? Shack-Hartman Wavefront Sensing Lenslet Array Shack-Hartmann Wavefront Sensor CCD Array Spot Array Wave Aberration Perfect Eye Aberrated Eye
5 Deconstruction of a Wavefront Hartmann-Shack Image Reconstructed Wavefront Defocus Astigmatism Coma Triangular Astigmatism Spherical Aberration radial order 2nd 3rd Zernike Modes Z 2 Z 2 astigmatism defocus astigmatism Z 2 0 ~ Conventional Refraction Higher Order Aberrations Z -3 Z -1 3 Z Z 3 trefoil coma coma trefoil 4th Z -4 4 Z 4 quadrafoil secondary astigmatism spherical -2 0 Z 4 Z4 2 Z4 4 secondary quadrafoil astigmatism 5th pentafoil -5 Z 5-3 Z 5 secondary trefoil Z 5 secondary coma -1 Z5 1 3 Z 5 secondary secondary coma trefoil pentafoil Z 5 5 Zernike Co-Efficients Astigmatic modes Comatic modes Trefoil modes Spherical Aberration
6 6.0 mm pupil Pupil Plane vs Retinal Plane Metrics Wavefront Point Spread Function Convolved Image Is There a Need for Contact Lenses Which Correct Higher Order Wavefront Aberrations?
7 Keratoconus Aberrations 1.5 3rd, 4th, & 5th Order Zernike Co-Efficients Zernike Co-Efficient Magnitude (um) Coma Spherical Aberration Z7 Z8 Z9 Z10 Z11 Z12 Z13 Z14 Z15 Z16 Z17 Z18 Z Normals Keratoconics Z20 Z21 Wavefront PSF Convolution 3mm Pupil 6mm Pupil LASIK Aberrations 0.8 Zernike Co-Efficients - Normal vs Refractive Surgery Populations 0.6 Coma NORMAL Spherical Aberration REFRACTIVE Z7 Z8 Z9 Z10 Z11 Z12 Z13 Z14 Z15 Z16 Z17 Z18 Z19 Z20 Z21
8 Wavefront PSF 3mm Pupil Convolution 6mm Pupil Normal Population Distribution Zernike Co-Efficient Distribution - Normal Population Pupil = 6.0mm 0.6 Zernike Co-efficient Magnitude (um) n = 838 Z311 Z331 Z400 Z421 Z441 Z511 Z531 Z551 Z310 Z330 Z420 Z440 Z510 Z530 Z550 Mean Mean±SD Min-Max HORMS vs Refractive Error 1.4 Relationship Between Refractive Sphere and Higher Order Wavefront Aberration of the Eye 1.2 n = 838 Pupil Size = 6.0mm 1.0 HORMS (um) % Refractive Sphere (D)
9 Designing Contact Lenses - Which Higher Order Wavefront Aberrations Should We Correct? Designing Custom Contact Lenses Wavefront Optimized : Partial HOA correction Usually Defocus and Spherical Aberration Rotationally symmetrical aberrations e.g. Purevision, Choice AB, Frequency55, Biomedics55 Premier Wavefront Guided: Full wavefront correction 2 nd thru 5 th or 6 th HOAs Symmetrical and non-rotationally symmetrical aberrations e.g. Ophthonix IZon, Technovision LaseLens, QuarterLambda SynergEyes W Population Spherical Aberration 280 Normal Population Spherical Aberration (Z 0 4) No of obs n = 838 Pupil Size = 6.0mm Spherical Aberration Z 0 4 (um)
10 Contact Lens Correction of Spherical Aberration - Case 1 Good 5.7mm Pupil Wavefront PSF Convolution Aspheric Contact Lens Optics Simplest custom contact lens design Corrects rotationally symmetric SA Based on population average Easily manufactured with lathe technology The Ideal Aspheric Design Spherical Aberration -6.00D -5.00D -4.00D -3.00D -2.00D -1.00D Power SF 1 SPHERICAL ANTERIOR LEVEL OF SPHERICAL ABERRATION TO THEORETICALLY OFFSET POPULATION AVERAGE (ASSUMING PERFECT LENS CENTRATION) SF<1-0.10µm ASPHERIC ANTERIOR -0.20µm
11 SA Population Distribution n = 838 Spherical Aberration vs Spherical Refractive Error Pupil Size = 6.0mm 0.5 Spherical Aberration - Z 0 4 (um) Refractive Error Sphere (D) SA Population Distribution 0.5 Spherical Aberration Following Average Population Value Offset Spherical Aberration (with Average Population Offset) (um) AvgOfPPRSphere Contact Lens Correction of Spherical Aberration - Case 2 Not So Good 5.7mm Pupil Wavefront PSF Convolution
12 Visual Impact Beyond SA Custom Correction of Wavefront Aberration with Contact Lenses - What Type of Lens Should We Use? Customized Contact Lenses - Effect of Rotation & Movement RMS of residual WA (microns) 1 2nd 3rd 0.8 4th order corrected up to 5th 6th translation (mm) 1 defocus & spherical ab rotation (deg) Gurao et. al. VSIA, 2000
13 Optimally Fit RGP Lenses Soft Lens Fitting Theory Soft Toric Lens Design - Orientation Mechanism Necessary
14 Custom Correction of Wavefront Aberration with Soft Contact Lenses - How to Manufacture? Manufacturing Techniques Custom Lathing: 3-axis lathe Sub-micron accuracy Hydration phase No polishing Cost effective Custom Molding: Personalized molds necessary Lathed or Ablated Plastic or Metal High Dk materials
15 Combined Molding/Lathing: Mold posterior surface Lathe anterior surface Manufacturing Techniques Direct Ablation: Anterior surface ablation of dry polymer High Order ablation on Low Order blank Small spot size Excimer Slow Expensive Measured Aberration of Customized Contact Lens Design Measurement 3 µm -3 µm Zernike coefficient (µm) rd 4th 5th Zernike mode : design : Measurement Residual HO rms = 0.25 µm WFG CLs: The Business Model Wavefront Sensor Measures Aberration in Clinician s Office Correcting Lens Design is Computed Remotely Via Internet Lens is Custom Packaged and Delivered to Doctor or Patient CNC Lathe Creates Non-Symmetric Customized Lenses
16 Custom Correction of Wavefront Aberration with Soft Contact Lenses - Can We Improve Vision? Correction of the eye s aberration using phase plate and measurement of visual performance Phase plate (pupil conjugate) Pupil camera Wavefront sensor CCD Eye Laser Artificial pupil Visual acuity Visual stimulus DMD projector Reduction of RMS Error Eye Eye + phase plate Rms wavefront error (µm) Total rms Higher order rms 6 6 6mm pupil 6mm pupil GY JP MM IC FE Mean GY JP MM IC FE Mean Subjects
17 Reduction of HOA: Feasibility Subject GY JP IC MM FE Eye 2nd order corrected 2nd + higher order corrected (phase plate) µm µm Reduction of HOA: Feasibility Subject GY JP IC MM FE Eye 2nd order corrected 2nd + higher order corrected (phase plate) 0.2 Improvement in VA Correcting 2nd order only Correcting 2nd + higher order High Contrast contrast (100%) letter Letter Low Low Contrast contrast (100%) (10%) Letter letter 20/ /32 Visual acuity (logmar) / / / / / /25 20/20 20/16 20/ /10 GY JP MM IC FE Mean GY JP MM IC FE Mean Subjects
18 Vision Correction with CCL for Keratoconics Sabesan (2007) Correction of 3 keratoconic eyes with Customized Soft Contact Lenses 45% water content hydrogels Standard B&L Optima Toric design - lathe cut Sphero-cylindrical over-refraction, 4 alternative forced choice acuity task Vision Correction with CCL for Keratoconics Sabesan (2007) Custom Correction of Wavefront Aberration with Soft Contact Lenses - Issues to Resolve?
19 Issues to Resolve Lens Centration Adaptation of the Visual System Line of Sight vs Visual Axis Cornea Pupil Center of the Pupil (Line of Sight) Center of Cornea Visual Axis Methods
20 Lens Centration Pupil Center Relative to Corneal Center Temporal Nasal Pupil Center Relative to Corneal Center - Vertical (mm) Pupil Center Relative to Corneal Center - Horizontal (mm) Visual Axis Displacement Relative to Pupil Center - Vertical (mm) Temporal Nasal Visual Axis Displacement Relative to Pupil Center - Horizontal (mm) Visual Axis Relative to Pupil Center Acquisition: Trial Lens Issues to Resolve Lens Centration Adaptation of the Visual System
21 Correction of Keratoconics (Sabesan & Yoon, 2009) Comparison of keratonic to normal eyes Real-time adaptive optics to correct HO aberrations 4 alternative forced choice acuity test Technically Feasible for a Large Percentage of the Population Needing Vision Correction To Be Maximally Effective It Requires Custom Correction of Individual Non-Rotationally Symmetric Wavefront Aberrations Up to and Including 5th Order Zernike. Can Be Delivered Within the Paradigm of Disposable Lenses Consistent Orientation and Centration of Lens Necessary Conclusion May Require Adaptation of the Visual System to Recognize Full Benefit
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